The effect of adhesive tape versus endotracheal tube fastener in critically ill adults: the endotracheal tube securement (ETTS) randomized controlled trial

Abstract

Background The optimal securement method of endotracheal tubes is unknown but should prevent dislodgement while minimizing complications. The use of an endotracheal tube fastener might reduce complications among critically ill adults undergoing endotracheal intubation. Methods In this pragmatic, single-center, randomized trial, critically ill adults admitted to the medical intensive care unit (MICU) and expected to require invasive mechanical ventilation for greater than 24 h were randomized to adhesive tape or endotracheal tube fastener at the time of intubation. The primary endpoint was a composite of any of the following: presence of lip ulcer, endotracheal tube dislodgement (defined as moving at least 2 cm), ventilator-associated pneumonia, or facial skin tears anytime between randomization and the earlier of death or 48 h after extubation. Secondary endpoints included duration of mechanical ventilation and ICU and in-hospital mortality. Results Of 500 patients randomized over a 12-month period, 162 had a duration of mechanical ventilation less than 24 h and 40 had missing outcome data, leaving 153 evaluable patients randomized to tube fastener and 145 evaluable patients randomized to adhesive tape. Baseline characteristics were similar between the groups. The primary endpoint occurred 13 times in 12 (7.8%) patients in the tube fastener group and 30 times in 25 (17.2%) patients in the adhesive tape group ( p = 0.014) for an overall incidence of 22.0 versus 52.6 per 1000 ventilator days, respectively ( p = 0.020). Lip ulcers occurred in 4 (2.6%) versus 11 (7.3%) patients, or an incidence rate of 6.5 versus 19.5 per 1000 patient ventilator days ( p = 0.053) in the fastener and tape groups, respectively. The endotracheal tube was dislodged 7 times in 6 (3.9%) patients in the tube fastener group and 16 times in 15 (10.3%) patients in the tape group ( p = 0.03), reflecting incidences of 11.9 and 28.1 per 1000 ventilator days, respectively. Facial skin tears were similar between the groups. Mechanical ventilation duration and ICU and hospital mortality did not differ. Conclusion The use of the endotracheal tube fastener to secure the endotracheal tubes reduces the rate of a composite outcome that included lip ulcers, facial skin tears, or endotracheal tube dislodgement compared to adhesive tape. Trial registration ClinicalTrials.gov NCT03760510. Retrospectively registered on November 30, 2018

Care for unplanned extubation prevention: analysis of the validity of an instrument’s content

“…Inadequate fixation of OTT is one of the most signalized procedures in the literature, associated with the occurrence of UPE (3,33) . Researches that address safety in the fixation of respiratory devices and their relationship with UPE have been developed (33)(34) , and it is known that UPE occurs mainly during the bath, at the time of lateralization of the body, and this is explained loss of centralization of the head (35) . A review study concluded that UPE can have serious consequences for patients, since reintubation is usually necessary (36) .…”

Medical device related pressure ulcer of the lip in a patient with COVID-19: Case report and review of the literature

“…They suggested that efforts should be focused on dressing materials applied prophylactically or more optimal securement of the tube. Landsperger et al [12] at Vanderbilt University sought to evaluate the safety of adhesive tape versus an endotracheal tube fastener. Based on their pragmatic, randomized trial, ETT-related lip ulcer occurred in 2.6% versus 7.3% (p = 0.05) of patients for rates of 6.8 versus 19.3 per 1000 patient ventilator days (p = 0.052) when comparing the fastener and tape groups, respectively.…”

Comparison of the effectiveness of endotracheal tube holder with the conventional method in a manikin model

“…In previous studies of other new commercially available Thomas tube holders in the prehospitalization setting and operation room, the Haider Tube-Guard (Haider Scientific, San Diego, CA, USA),[ 20 ] the Shiley™ Evac Endotracheal Tube with TaperGuard™ Cuff (Medtronic, Dublin, Ireland),[ 21 ] the Thomas tube holder,[ 10 19 ] and the AnchorFast Oral Endotracheal Tube Fastener (Hollister, Libertyville, IL, USA) have significantly reduced the displacement of the ET tube in comparison with adhesive tape and reduces the rate of lip ulcers and facial skin tears. [ 22 ]…”